Download Advances in Nitrate Therapy by Adam Schneeweiss MD, Marija Weiss DSc (auth.) PDF

By Adam Schneeweiss MD, Marija Weiss DSc (auth.)

Nitrates were for a few years the cornerstone of cardiovascular remedy for numerous symptoms. not just have nitrates stood the attempt of time for therapy of persistent reliable angina pectoris, however the symptoms for them have markedly ex­ panded. They now comprise all different types of angina pectoris and myocardial ischemia, congestive middle failure and hypertensive emergencies. The worthy results of nitrates in a lot of these stipulations end result from their vasodilatory homes, however it remains to be doubtful even if the important or peripheral results predominate within the thera­ peutic mechanism. lately nitrates were proven to satisfy crucial requirement for every and each drug - to lessen mortality. a wide scale learn published that isosorbide dinitrate, mixed with hydralazine, decreased long term mortality through 28% in sufferers with congestive middle failure. This discovering will surely stimulate study on nitrates, and it'd be anticipated that curiosity in those medications will markedly elevate. The basically used nitrates in medical perform are nitroglycerin and the com­ plex natural nitrates, generally isosorbide dinitrate. The natural mononitrates at the moment are lower than scientific research, and isosorbide-5-mononitrate (IS-5-MN) seems to be specially promising.

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Advances in Nitrate Therapy

Nitrates were for a few years the cornerstone of cardiovascular remedy for varied symptoms. not just have nitrates stood the try of time for remedy of persistent solid angina pectoris, however the symptoms for them have markedly ex­ panded. They now comprise all kinds of angina pectoris and myocardial ischemia, congestive middle failure and hypertensive emergencies.

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Drugs that have been developed purely for treatment of hypertension, such as the angiotensin converting enzyme inhibitors (ACEI) are now evaluated for treatment of angina pectoris, with variable results. Even alpha-adrenoreceptor blockers such as prazosin were found effective in certain forms of angina pectoris. Antianginal drugs act mainly by two mechanisms: 1. Reduction in myocardial oxygen demand; 2. Increase in myocardial blood supply. It is the delicate interplay between the pathophysiology in any individual patient and the relative effect of drugs on either mechanism that determines the suitability of a specific drug for an individual patient.

2. Beta-Blockers As beta-blockers and nitrates act by different mechanisms in angina pectoris, their combination might increase the antianginal efficacy. Moreover, their combined use may eliminate problems associated with monotherapy. For example, sympathetic activation due to nitrate-induced vasodilation may prevent the excessive slowing of heart rate by beta-blockers. Coronary vasodilation by nitrates can counter the unopposed alpha-adrenergic stimulation in the coronary arteries of patients treated with nonselective beta-blockers.

Although calcium antagonists may improve myocardial performance in some of these patients, it is not rational to use agents with a negative inotropic effect when agents with no such effect may be used. Moreover, nitrates are an established therapy for heart failure and in patients with combined angina pectoris, and heart failure monotherapy with nitrates is effective for both conditions. It should also be remembered that in some cases nifedipine has actually aggravated heart failure. At present there is one theoretical advantage for the use of beta-blockers in patients with postinfarction angina - the possibility of secondary prevention.

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